POS0294 ARTIFICIAL INTELLIGENCE TO CONNECT THE USE OF BIOLOGICS AND SMALL MOLECULES IN RHEUMATOID AND PSORIATIC ARTHRITIS WITH A MULTIDISCIPLINARY EVALUATION: A REAL WORLD EVIDENCE APPROACH THROUGH NATURAL-LANGUAGE PROCESSING
Authors: P. Moranding, F. Maffia, F. Puggioni, F. Motta, M. Vecellio, A. Costanzo, V. Savevski, C. Selmi
Journal: Annals of the Rheumatic Diseases (2022)

Background The management of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) is often relying on a multidisciplinary approach with different specialists evaluating the patient for treatment choices. The ultimate impact of such management on the use of systemic glucocorticoids and more innovative drugs such as biologics and small molecules, however, is unclear. Artificial intelligence tools, particularly natural language processing and machine learning, allow to manage large datasets and investigate associations between variables. Objectives To use a natural language processing approach to demonstrate whether a multidisciplinary approach to RA or PsA changes treatment choices. Methods We analysed the clinical notes of hospital encounters between 2017 and 2020 of patients with a terminated or ongoing care process at outpatient clinics included in the Humanitas Center for immune-mediated disease. To extract structured information from text data we used regular expressions (RegEx), a technique that allows to define elastic search patterns. RegEx were also used to detect negations to consider only affirmative citation of diseases or prescribed therapy. Care processes were described by binary flags which express the presence of RA or PsA and the prescription of glucocorticoids and biologics /small molecules for each patient. Working with only categorical data, we relied on the chi squared test to detect possible correlations between prescribed treatments and the characteristics of the care process, including whether a multidisciplinary evaluation had occurred. Results Our analysis included 1839 patients with RA (77% women, mean+standard deviation age 58±16 years) and 1652 patients with PsA (46% women, age 57±15 years), accounting for 5517 and 3992 outpatient visits with different specialists over the study period, respectively. Among patients with RA and PsA, 378 (22%) and 371 (25%) were prescribed biologics or small molecules, respectively, while 830 (47%) RA and 431 (29%) PsA cases received a prescription for systemic glucocorticoids during one of the visits and patients seen three of more times by the rheumatologists received significantly more biologics / small molecules. Importantly, 4.5% of patients with RA and 9.4% of patients with PsA were evaluated also by dermatology, gastroenterology, allergy and pulmonary disease specialists and these patients were treated more frequently with glucocorticoids (70% vs.47% for RA, P&lt;0.001; 60% vs. 29% for PsA, P&lt;0.001) as well as with biologics / small molecules (42% vs. 22% for RA, P&lt;0.001; 58% vs. 25% in PsA, P&lt;0.001). Conclusion Natural language processing and machine learning were applied to unstructured electronic clinical charts in a large Center dedicated to immune-mediated diseases and allowed to demonstrate that patients with RA or PsA undergoing multiple evaluations are more likely to receive biologics or small molecules. Disclosure of Interests Pierandrea Moranding: None declared, Fiore Maffia: None declared, Francesca Puggioni Consultant of: Sanofi, GSK, Novartis, Teva, Francesca Motta: None declared, Matteo Vecellio: None declared, Antonio Costanzo Speakers bureau: bbvie, Almirall, Amgen, Lilly, Novartis, Galderma, Boehringer, Janssen, Leo Pfarma, Pfizer Sanofi, Celgene, Paid instructor for: Abbvie, Almirall, Amgen, Lilly, Novartis, Galderma, Boehringer, Janssen Leo Pfarma Pfizer, Sanofi, Celgene, Grant/research support from: bbvie, Janssen, Novartis, Victor Savevski: None declared, Carlo Selmi Speakers bureau: AbbVie, Amgen, Alfa-Wassermann, Biogen, Celgene, Eli-Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi-Genzyme, Paid instructor for: AbbVie, Amgen, Alfa-Wassermann, Biogen, Celgene, Eli-Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi-Genzyme, Consultant of: AbbVie, Amgen, Alfa-Wassermann, Biogen, Celgene, Eli-Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi-Genzyme, Grant/research support from: AbbVie, Amgen, Janssen, Pfizer